Paediatric Clinical Practice Guideline …

Paediatric Clinical Practice Guideline

Lymphadenopathy and Lymphadenitis

Author: Publication date: Review date:

David Lawrence, Jane Ding, Katy Fidler, Miki Lazner, Catherine Wynne April 2017 ? updated from September 2014 April 2019

Skip straight to lymphadenitis guideline

Background

Most lymphadenopathy is due to benign self-limited disease, such as viral or bacterial infection

Lymph nodes < 1cm are normal in children aged < 12 years. Axillary nodes up to 1 cm and inguinal nodes up to 1.5 cm also usually normal.

If swelling is near the jaw line consider a dental infection ? will need referral to MaxFacs, antibiotics, and OPG x-ray. See dental infections guideline.

Supraclavicular nodes of any size at any age warrant further investigation

Definitions

Lymphadenopathy: enlarged lymph node(s). LN > 2cm have increased chance of being caused by serious pathology.

Lymphadenitis: enlarged lymph node that is due to an inflammatory / infective process; usually warm, tender, erythematous +/- systemically unwell

Generalised lymphadenopathy: lymph nodes enlarged in 2 or more non-contiguous areas Localised lymphadenopathy: lymph nodes enlarged in only one area

Acute lymphadenopathy: < 2 weeks Subacute lymphadenopathy: 2 ? 6 weeks Chronic lymphadenopathy: > 6 weeks

Aetiology See endnotes for a quick guide to infections.

Timing Symmetry

Common

Lymphadenitis ? staph aureus and group

Unilateral A strep

Acute

Newborn: staph aureus Viral URTI ? adenovirus, influenza, RSV

Bilateral Group A strep (age >3yrs)

EBV

Non-tuberculous mycoplasma (age 50%), fever, malaise, older children, posterior cervical and / or generalised nodes.

Clinical features not useful in distinguishing the two, recent URI or impetigo, node 3-6cm, 25-33% suppurate and fluctuant

"Cellulitis-adenitis" syndrome, febrile, irritable, poor feed, submandibular, node with overlying cellulitis, bacteraemia common. Exclude concurrent meningitis in neonates. Recurrent bacterial infection, opportunistic infection, fever, diarrhoea, encephalopathy, failure to thrive, hepatosplenomegaly, generalised lymphadenopathy. Conjunctivitis, skin peeling on hands, diffuse rash, strawberry tongue, fever, single non-tender non-purulent node Signs are very characteristic, submandibular (87%) and preauricular/parotid (9%), mostly unilateral (98.6%), violaceous discoloration of overlying skin, tender, rubbery

Rash, fever, malaise, anorexia, weight loss, hepatomegaly, LN near site of chancre or generalised. Epitrochlear LN. Mostly asymptomatic, myalgia, fatigue, fever, splenomegaly, maculopapular rash, cat exposure, ingestion of partially cooked meat

Diffuse non-tender nodes, may persist for weeks, especially ENTrelated.

BSUH Clinical Practice Guideline ? Lymphadenopathy and Lymphadenitis Page 5 of 5

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